Provider Demographics
NPI:1679930200
Name:CHAPMAN, KATHRYN GRACE (LCPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GRACE
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4044 N LINCOLN AVE STE 198
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3038
Mailing Address - Country:US
Mailing Address - Phone:773-217-9087
Mailing Address - Fax:
Practice Address - Street 1:4044 N LINCOLN AVE STE 198
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3038
Practice Address - Country:US
Practice Address - Phone:773-217-9087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional